Fillable APPLICATION FOR OCEAN CARGO INSURANCE (RT Specialty)

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APPLICATION FOR OCEAN CARGO INSURANCE (RT Specialty)

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The APPLICATION FOR OCEAN CARGO INSURANCE (RT Specialty) form is 3 pages long and contains:

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  • 29 check-boxes
  • 52 other fields

Country of origin: US
File type: PDF

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OM-Cargo app (12/97)
APPLICATION FOR
OCEAN CARGO INSURANCE
Date:
OPEN POLICY TRIP RISK ONE YEAR TERM POLICY
NAME OF INSURED (Include names of all subsidiary firms or corporations to be insured):
ADDRESS OF INSURED:
NAME OF AGENT OR BROKER:
GEOGRAPHICAL LIMITS:
U.S. TO WORLD WORLD TO U.S. WORLD TO WORLD RIVER SHIPMENTS
GREAT LAKES OTHER:
VALUATION:
AMOUNT OF INVOICE, INCLUDING CHARGES, PLUS OCEAN FREIGHT, PLUS %
OTHER:
PRINCIPAL MERCHANDISE TO BE INSURED (Enclose pictures or illustrated catalogs, if available):
PACKING - DESCRIBE IN DETAIL (enclose pictures and diagrams of packing, if available):
INSURING CONDITIONS:
ALL RISKS DEDUCTIBLE $ % FRANCHISE $ % FREE OF PARTICULAR AVERAGE
WITH AVERAGE 3% WITH AVERAGE I.O.P.
OTHER:
SPECIAL CONDITIONS
WAR RISK CONTINGENT INTEREST DIFFERENCE IN CONDITIONS SR & CC FOB/FAS
INCREASED VALUE DUTY COVERAGE WAREHOUSE COVERAGE - Attach list of locations
OTHER:
Submit Form
OM-Cargo app (12/97)
LIMITS OF INSURANCE
$ BY ONE VESSEL $ REGISTERED OR GOVT. INSURED PARCEL POST
$
BY ANY ONE VESSEL ON DECK
$
BY ANY ONE AIRCRAFT
$
BY ANY ONE TRUCK/R.R. TRAIN $ UNREGISTERED OR ORDINARY PARCEL POST
$
BY ANY ONE BARGE
DESCRIBE NATURE OF ISSURED’S BUSINESS (Manufacturer, Exporter, Commodity Broker, etc.):
EXPORTS IMPORTS
INSURED VOLUME during the last 12 months
$ $
ESTIMATED VOLUME to be insured during the next 12 months
$ $
ESTIMATED AVERAGE VALUE PER SHIPMENT
$ $
PRINCIPAL COUNTRIES TO WHICH GOODS ARE EXPORTED (Indicate % involved):
PRINCIPAL COUNTRIES FROM WHICH GOODS ARE IMPORTED (Indicate % involved):
NAME OF PRESENT INSURANCE COMPANY:
NAME OF PRESENT BROKER:
PREMIUM AND LOSS EXPERIENCE FOR PAST YRS (attach loss analysis if available):
WAREHOUSE
EXPORTS IMPORTS
PREMIUM (excluding War)
$ $
$
LOSSES PAID AND OUTSTANDING
$
$
$
PRINCIPAL KIND OF LOSS:
PRINCIPAL COUNTRIES INVOLVED IN LOSSES:
REMARKS: (attach extra sheets if necessary)
QUOTED
DECLINED Reason:
BINDING Effective Date:
OM-Cargo app (12/97)
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APPLICATION FOR OCEAN CARGO INSURANCE (RT Specialty)

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Completed 31 July 2020

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